Al-Akhawayni and the early descriptions of meningitis

Abubakr Rabi-ibn Ahmad Akhawayni Bukhari, also known as Al-Akhawayni, was a Persian physician who lived in the Near East during an age in which medical knowledge blossomed in the Islamic world. This era, the "Islamic Golden Age," extended from the tenth to the twelfth centuries AD. During his lifetime as a physician, Al-Akhawayni was famous for his expertise in medicine, including disorders that would be considered neurological today. In his extant book Hidayat al-Muta`allemin fi al-Tibb [A Scholar's Guide to Medicine], he provided an early description of what is probably meningitis. He illustrated the membranes surrounding the brain tissue in detail and described manifestations resulting from their inflammation.

["Meningitis epidemic" in Italy in 2007]

Immuno and chemo prophylaxis are at present valid tools for meningitidis control and prevention. Meningitidis is however a severe, not infrequent, disease, with a great emotional impact on the population, as shown by the reactions that followed the recent epidemic in Veneto. Public Health personnel must be prepared to give a rapid and correct information in order to allow everybody to act properly to maintain health.

The irony of being Oscar: the legendary life and death of Oscar Wilde

In this second in a series of famous historic personages who suffered from ear disease (see Yardley M, Rutka J. Troy, Mycenae, and the Otologic Demise of Herr Heinrich Schliemann. J Otolaryngol 1998; 27:217-221), we review the life and otology-related death of the legendary playwright Oscar Wilde. In his time, Wilde ridiculed the social hypocrisy of the Victorian age, championed the individual, and pleaded for a more tolerant and forgiving society in his many books, plays, and letters. Very much the acerbic and iconoclastic wit, Wilde's private and later very public affair de coeur with Lord Alfred Douglas, the son of the Marquis of Queensberry, still continues to interest and paradoxically shock our sensitivities. Wilde's ultimate demise from an otogenic bacterial meningitis appears all the more ironic when one considers the role his father, Sir William Wilde, played as one of the founding fathers of modern otology.

Cerebrospinal fluid analysis in clinical diagnosis

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A Canadian doctor in Zaire

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[Incidence and characteristics of childhood suppurative meningitis in Hungary in 1983-87]

Data of 1208 infants and children hospitalized for purulent meningitis were analysed. The incidence of the disease was closely age related: morbidity calculated for 100,000 children was found 97.5 under one year of age; 15.6 in 1 to 5 and 2.2 in 6 to 14 years of age. Incidence of newborn meningitis cases was 3.7 per 10,000 live-borns. The disease was caused by N. meningitidis in 278 (23%), H. influenzae in 171 (14%), S. pneumoniae in 157 (13%), E. coli in 74 (6%), B-group streptococcus in 61 (5%), other bacteria (altogether 17 species) in 107 (9%) cases, while in 360 cases (30%) the etiology remained unknown. Overall case fatality was 19.6 per cent. When compared to international data mortality was especially high among the newborns (53%) and in meningitis cases due to S. pneumoniae (29%), E. coli (48%), B-group streptococcus (37%) and "other bacteria" (41%). Neurologic sequelae were found in 17 per cent of the patients at discharge however, in newborns it was 54 per cent. Since the antibacterial therapy was appropriate in all cases, authors try to reveal the possible causes of the relatively high mortality and make recommendations for reducing it.

Changing spectrum of pediatric neurologic disorders during 18 selected years, 1900-1980, at the Hospital of University of Tokyo

In order to assess the changing pattern of pediatric neurologic disorders during this century, we retrieved and analyzed the medical records of hospitalized patients with neurologic disorders in our hospital from 1900 to 1980. It was demonstrated that bacterial meningitis had been by far the most common cause of death until 1950. After 1950, both the incidence and the mortality rate of bacterial meningitis declined rapidly probably because of the improved medical care and introduction of various antibiotics. We noticed several interesting features in the changing spectrum of bacterial meningitis as described below. First it was demonstrated that the incidence of tuberculous meningitis declined almost a decade later than those of other kinds of purulent meningitis. Second, the incidence of bacterial meningitis declined even before the introduction of antibiotics. Although the development of antibiotics was the main contributing factor in improving the prognosis for bacterial meningitis, it is suggested from our data that other factors such as improved general supportive care and carrying out of public health programs also played an important role in improving the overall prognosis for bacterial meningitis.

Kernig's and Brudzinski's signs revisited

Although meningitis has been recognized since antiquity, the clear description of signs of meningeal irritation is relatively recent. Kernig's sign is described in physical diagnosis texts; however, the test for Kernig's sign as currently performed differs from Kernig's original description. Brudzinski described several signs of meningitis; his "nape of the neck" sign is the best known. The contralateral leg signs described by Brudzinski are unfamiliar to most clinicians. Brudzinski believed that knowledge of all the meningeal signs was of use because some may be present while others are absent. Since outcome in meningitis is dependent on early treatment--and therefore early diagnosis--familiarity with all the meningeal signs is desirable.

Osler and neurology

William Osier’s bibliography includes over 1400 papers, monographs, and notes touching on almost every subspecialty of medicine (Abbott 1939). He has been claimed by gastroen-terologists (Cunha 1948), pediatricians (McGovern et al 1970; Robbinsetal 1963), medical librarians, (Bett 1949), veterinarians (Giltner 1926–27) (Murphy 1960) obstetricians (Rucker 1952) and members of other disciplines as one of their own.

Osier published close to 200 papers, reviews, editorials and monographs dealing with neurology, but it is not widely recognized that his contributions to neurology exceed those to many of the other fields. For example, Osier’s interest in neuropathology was entirely omitted from the recent excellent monograph “An Oslerian Pathology” (Rodin 1981). The purpose of this paper is to bring into focus his impressive neurological contributions and to document his substantial interest in the neurosciences.

Osier’s activities in neurology constituted a microcosm of his overall medical contributions. His interests in the neurosciences began early. In 1884 he wrote on the comparative anatomy of the brain of the seal (Osier 1884a), having given a lecture on “the brain as a thinking organ” in the previous year (Osier 1883a).